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FRECEIVEl~ FROM:
IF~VIN F~ANIfLIN b
1 ~S QOi~SEYS ~,ANE
DILLSSUR(3, i*"A 1701;
<.R , bM
ESTATE INFQRMATION: SSN: tg3.2a-Q9ll6
FINE NUMREPR: ~1 1 ~~-Q232
DECEDENT NAME: WALTON RICHARD A
DATE OF PAYMENT: 03/ 16/201
PosTMARK DATE: 03/16/2012
CAUNTY. GUMBEf~I.AND
DATE OF QEATH: U2/15/2012
REM~-AI~S:
RENAlSYGYARIIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
R&V•t1f32 EX~11.861
IBC?. ~D Q15716
A0N
ASSESSMENT AMC?UNT
CONTRtOL
NUMBER
1~114~41 ~ ~1,~b1.13
TOTAL AMOUNT PAID:
CMEDK#t 101
INITIALS: FIMW
sEa~ RECEIVED ~~':
GLENDA EARNER ST`RABBA-UC3M
REGISTER OF WILDS
A~~i~T~~ ~~ wi~.l.&
_ __ _ __ _T-~- __ _ _ __
;,r _
B PENNSYLVANIA INHERITANCE TAX ~`D~3Z
BUREAU of INDIVIDUAL TAxes _ ~ ORMATION NOTICE FILE N0. 21'r
PO BOX 280601 enn dFF~ AND
HARRISBURG PA n12a-o6ol P jj'~~ ! ~' ACN 12114341
DEPARTMENT \,/1 ~+.~:,.;_.~TAXPAYER RESPONSE DATE 02-28-2012
REV-15f3 EX fFP [,5-117
;_ ~ MAR I E? PM ~ ~, TYPE OF ACCOUNT
EST. OF RICHARD A WALTON ~ SAVINGS
~{,~}( (~~' SSN 193-24-0765 Q CHECKING
QRPf'}~'s(~, ~p DATE OF DEATH 02-15-2012- ^ TRUST
'`~,~)~~~~~ C('., ~~ COUNTY CUMBERLAND ®CERTIF.
REMIT PAYMENT AND FORMS T0:
FRANKLIN IRVIN REGISTER OF WILLS
126 DORSEYS LN 1 COURT-HOUSE SQUARE
DILLSBURG PA 17019-9573 CARLISLE PA 17013
MEMBERS i ST FCU provided the department with the information below. which was used in calculating tfie inheritance-tax due.
Records Tndicat~,tfiat at the death of the above-named decedent, you were a Joint owner/beneficiary of this account. If yoU are the, spouse Of the
deceased aAd any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must
notify the deyarteent of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2.
If you believe the information is incorrect, Dl ease obtain written correction from the financial institution, attach a copy to this form and return
it to the above address. Please call 717-787-8327 with puestions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 44604-40 Date 04-15-1986 To ensure proper credit to the account, two
Established copies of this notice trust accompargr
60 , 050.17 pavm®nt to the Register of Wills. Make chock
Account Balance ~ payable to "Repistor of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments era made within three
Amount Subject to Tax ~ 30, 025.09 ^ontha of the decedent's date of death,
Tax Rate X .045 deduct a 5 percent discount on the tax duA.
Arry inheritance tax due will become delinquent
Potential Tax Due $ 1, 351.13 nine eonths after rho date of death.
P~T TAXPAYER RESPONSE
1
.,
A. ,I~{ The above inforaation'and tax due is correct.
(~/lA Reait payaent to the Rapister of Wills with two .copies of this notice to obtain
CHECK a discount or avoid interest, or return this notice to the Register of Wills and
ONE an official assessment will be issued by the PA Departaent of Revenue.
BLOCK ] B. ~ The above asset has bean or will be reported and tax paid with the Pennsylvania inheritance tax return
ONLY filed by the estate reprosentative.
C. ~ The above info a ion is incorr ct and/or debts and deductions were paid.
Complete PART ~ and/or PART 3~ below.
ppRT If indicating a different tax rata, please state
relationship to decedent:
TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Date Established 1
2. Account Balance 2 ~
3. Percee-t Tatcsbla_ 3- X ,- _. _. __ _ __
4. Amount Subject to Tax 4
5. Debts and Deductions 5
6. .Amount Taxable 6 ~
7. Tax Rate 7 X
E. Tax Due 8 ~
PART DEBTS AND DEDUCTIONS CLAIMED
0
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
TOTAL..Chnter on Lane 5 of Tpx GompYtatiOA) ~ i
°Undir pin~ilti~s of.,per~ury, I declare that th® facto I reported above at's true, corrpetparisi '"
.Camp. t~'~o th t of my noaledgp and belief. HOME Cry'' ) ~/~~
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